Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
Can J Urol. 2020 Apr;27(2):10162-10166.
Phyllanthus niruri (P. niruri) is the most commonly listed active ingredient in commercially available herbal therapies for kidney stones, despite limited supporting clinical evidence. We performed a meta-analysis to evaluate its efficacy in reducing stone burden. We used Google Trends to analyze its relative popularity in internet searches relative to conventional stone therapies.
A comprehensive literature search for controlled human studies containing data on the effect of P. niruri treatment on stone size and number was performed. Pooled analysis of change in mean stone size and number with P. niruri was performed using a fixed-effects model. Standardized mean difference (SMD) and 95% CI were reported. Google searches in the United States within the 'Health' category, for topics 'Gale of the wind (P. niruri)', 'Extracorporeal shockwave lithotripsy' (ESWL), 'Ureteroscopy' (URS), 'Laser lithotripsy' (URSL) and 'Percutaneous nephrolithotomy' (PCNL), conducted between January 2014 and December 2018, were quantified. Annual median relative search volumes (RSV; 0-100 scale) were compared using the Kruskal-Wallis test. Post-hoc pairwise comparisons were performed using the Dunn test with Holm-Sidak adjustment.
Two studies met inclusion criteria. P. niruri treatment resulted in significant decreases in mean stone size (SMD -0.39 cm, 95% CI = -0.68 to -0.09, p = 0.01) and number (SMD -0.38, 95% CI = -0.68 to -0.09, p = 0.01). Median RSV for P. niruri was similar to that for ESWL, PCNL and URS through 2015, but was significantly higher than for ESWL and PCNL after 2015, and higher than for URS after 2016 (each p value p ≤ 0.0012).
Limited clinical evidence supports modest efficacy of P. niruri in reducing stone burden, pending further study. Public interest in P. niruri is growing within the United States, possibly reflecting a rising demand.
垂盆草（P. niruri）是市售用于治疗肾结石的草药疗法中最常被列入的有效成分，尽管其支持临床疗效的证据有限。我们进行了一项荟萃分析，以评估其在减轻结石负担方面的功效。我们使用 Google Trends 来分析其在互联网搜索中相对于传统结石治疗方法的相对流行程度。
我们对包含垂盆草治疗对结石大小和数量影响的数据的对照人体研究进行了全面的文献检索。使用固定效应模型对垂盆草治疗后结石大小和数量的变化进行了汇总分析。报告了标准化均数差（SMD）和 95%置信区间。在 2014 年 1 月至 2018 年 12 月期间，在美国“健康”类别中对主题“ Gale of the wind (P. niruri)”、“体外冲击波碎石术”（ESWL）、“输尿管镜检查术”（URS）、“激光碎石术”（URSL）和“经皮肾镜取石术”（PCNL）进行了 Google 搜索，并对其进行了量化。使用 Kruskal-Wallis 检验比较了每年中位数相对搜索量（RSV；0-100 刻度）。使用具有 Holm-Sidak 调整的 Dunn 检验进行了事后两两比较。
两项研究符合纳入标准。垂盆草治疗可显著降低结石的平均大小（SMD-0.39cm，95%CI=-0.68 至-0.09，p=0.01）和数量（SMD-0.38，95%CI=-0.68 至-0.09，p=0.01）。垂盆草的中位数 RSV 与 ESWL、PCNL 和 URS 相似，直至 2015 年，但在 2015 年之后，其 RSV 显著高于 ESWL 和 PCNL，在 2016 年之后，其 RSV 也高于 URS（每个 p 值 p≤0.0012）。
有限的临床证据支持垂盆草在减轻结石负担方面具有适度的疗效，但还需要进一步研究。美国公众对垂盆草的兴趣正在增长，这可能反映了需求的增加。
